Medicare and Medicaid are an integral part of the United States’ federal healthcare benefit programs, collectively accounting for billions of dollars of federal expenditures each year. Due to the sheer size of the programs, a significant amount of healthcare fraud allegations can occur in any given year and are often aggressively investigated. Individuals and groups that are accused of Medicare or Medicaid fraud are subject to intense scrutiny and, if convicted, face the possibility of significant sanctions. If you have been accused of Medicare or Medicaid fraud in Virginia, you should speak with a Virginia Medicare Medicaid fraud attorney who is experienced in successfully defending clients facing similar charges.
Common Types of Medicare or Medicaid Fraud
There are many ways that an individual or business could be accused of engaging in Medicare or Medicaid fraud. Some of the more common accusations include the following:
- Billing for services that were not performed
- Billing for unnecessary medical procedures and tests
- Overbilling for services provided
- Providing inexpensive medical equipment but billing for a more expensive model
- Falsifying diagnoses
- Waiving patient costs and overbilling the insurance company or federal government
- Accepting or providing kickbacks for patient referrals
Penalties Associated with Medicare and Medicaid Fraud
Accusations of Medicare or Medicaid fraud can result in serious criminal penalties and may threaten one’s livelihood. This could include the loss or denial of a professional license or perhaps deportation if the individual is not an American citizen. For these reasons it may be in the best interest of the accused to contact a Virginia Federal Medicare and Medicaid Fraud lawyer.
In addition to there being several types of Medicare and Medicaid fraud claims, there are also several federal laws that could be implicated in a health care fraud scenario. Some of the more common include:
- The False Claims Act – The Federal False Claims Act (FCA) prohibits parties from defrauding the government by submitting false claims. The FCA exposes parties that submit false claims to the government to civil liability.
- The Anti-Kickback Statute – This law criminalizes providing kickbacks in order to induce or reward referrals that could be reimbursed through a federal health care program, such as Medicare or Medicaid. For example, a health care provider that paid a referral fee to a physician in return for the doctor to refer his or her patients to the provider would be in violation of the Anti-Kickback Statute. The potential penalties associated with violating this law include fines and imprisonment.
- The Stark Law – The Stark Law prohibits physicians from making referrals for specific health services to a provider or entity in which the physician or a member of his or her immediate family has a financial interest or with whom the physician has an investment interest
- The Criminal Health Care Fraud Statute – 18 U.S. Code Section 1347 makes it illegal to knowingly and willfully execute, or attempt to execute, any “scheme or artifice” to defraud a healthcare benefit program or to fraudulently obtain health care program money or property.
Distinguishing Between Fraud and an Honest Mistake
In any criminal proceeding alleging fraud, it is important to distinguish between intentional deception and an honest mistake. Most allegations, however, can be addressed and fought. This might include having any or all of the charges dropped or mitigating any potential penalties if conviction appears unavoidable. The distinction between an honest mistakes and fraud tends to be very fact-specific, and a skilled Virginia Medicare or Medicaid fraud lawyer will what kind of evidence to present to see the charges eliminated or reduced.
